Exclusive Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannoma Resection: A Case Series

OBJECTIVE To demonstrate successful surgical management of vestibular schwannomas via an exclusively endoscopic transcanal transpromontorial approach (EETTA). PATIENTS Four patients with vestibular schwannomas. INTERVENTIONS Surgical excision via EETTA. MAIN OUTCOMES Technique refinements, tumor access, complete tumor removal, and patient morbidity. RESULTS Three tumors were Koos grade I and one tumor was Koos grade II. All ears had non-serviceable hearing prior to surgery. The EETTA enabled access to the internal auditory canal and porus acousticus as well as limited access to the cerebellopontine angle. Gross total tumor resection was achieved in all cases. There were no intraoperative or postoperative complications and the mean hospital duration was 2.8 days. After a mean follow-up of 5.0 months, all cases had a good facial nerve outcome. CONCLUSIONS The EETTA can be successfully used for the management of small vestibular schwannomas in ears without serviceable hearing. Additional studies are needed to fully elucidate the risk-benefit profile of this minimally invasive approach.

[1]  G. Pavesi,et al.  Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment. , 2017, Journal of neurosurgery.

[2]  Maura K. Cosetti,et al.  Defining the Limits of Endoscopic Access to Internal Auditory Canal. , 2016, The journal of international advanced otology.

[3]  David Choi,et al.  Endoscopic Endonasal Anterior Skull Base Surgery: A Systematic Review of Complications During the Past 65 Years. , 2016, World neurosurgery.

[4]  Daniel J. Lee,et al.  Endoscopic Transcanal Retrocochlear Approach to the Internal Auditory Canal with Cochlear Preservation , 2016, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[5]  Jack H Noble,et al.  Comparison of Middle Ear Visualization With Endoscopy and Microscopy , 2016, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[6]  Marc L. Bennett,et al.  The Utility of a Predictive Model for Cochlear Implant Operating Time , 2016, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[7]  Daniel J. Lee,et al.  Prolonged Radiant Exposure of the Middle Ear during Transcanal Endoscopic Ear Surgery , 2015, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[8]  D. Marchioni,et al.  Endoscopic transcanal corridors to the lateral skull base: Initial experiences , 2015, The Laryngoscope.

[9]  G. Pavesi,et al.  Combined endoscopic-microscopic approach for vestibular schwannoma removal: outcomes in a cohort of 81 patients , 2014, Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale.

[10]  Daniel J. Lee,et al.  Thermal effects of endoscopy in a human temporal bone model: Implications for endoscopic ear surgery , 2014, The Laryngoscope.

[11]  K. Niemczyk,et al.  Comparison of visualization of the middle ear by microscope and endoscopes of 30° and 45° through posterior tympanotomy , 2014, Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques.

[12]  A. Cohen-Gadol,et al.  Surgery for vestibular schwannomas: a systematic review of complications by approach. , 2012, Neurosurgical focus.

[13]  N. Surgery.  [Facial nerve grading system]. , 2006, Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery.

[14]  C. Matula,et al.  Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. , 1998, Journal of neurosurgery.

[15]  C. Cingi,et al.  Endoscopic ear surgery , 2019, Journal of otology.

[16]  P. Roland,et al.  Modified Rambo meatoplasty in translabyrinthine tumor removal , 1991, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[17]  J. Thomassin,et al.  [Endoscopic ear surgery. Initial evaluation]. , 1990, Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris.

[18]  J. Rambo.  Primary closure of the radical mastoidectomy wound; a technique to eliminate postoperative care , 1958, The Laryngoscope.